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Biomedical subjects

N H Holland

Publications and source records attributed to N H Holland.

At least 19 recordsLinked to original sources
PubMed1995

IgA nephropathy: long-term prognosis for pediatric patients.

OBJECTIVE: The determination of the ultimate prognosis for patients with IgA nephropathy diagnosed in childhood requires long-term follow-up of identified patients. The purpose of this study was to obtain such follow-up for patients from two centers where the disease has been diagnosed for more than 20 years. METHODS: Clinical data at the apparent onset of symptoms and renal histologic data were obtained for 103 patients in whom IgA nephropathy was diagnosed before age 18 years. Clinical status at last follow-up was obtained from office records or from direct contact with the patient. Predicted kidney survival was determined by the Kaplan-Meier method. Follow-up of more than 10 years from the time of biopsy was available for 40 of the patients. RESULTS: Fourteen of the patients have progressed to end-stage renal disease; three others have progressive chronic renal insufficiency as defined by an estimated creatinine clearance of less than 50 ml/min per 1.73 m2. Severity of the renal histologic findings and the degree of proteinuria at the time of biopsy were associated with poor outcome. For all patients, predicted kidney survival from the time of apparent onset was 94% at 5 years, 87% at 10 years, 82% at 15 years, and 70% at 20 years. Age at clinical onset and gender were not associated with poor outcome, but black race and severity of renal histologic findings were. CONCLUSION: With follow-up into adulthood, the outcome for pediatric patients with IgA nephropathy appears to be as serious as that reported in adult patients. Follow-up of a pediatric patient with persistent clinical findings should be maintained after the patient's care is transferred to a physician caring for adults.

Adolescent↗
PubMed1990

Relation of urinary tract infection and vesicoureteral reflux to scars: follow-up of thirty-eight patients.

A prospective study compared the outcome of vesicoureteral reflux and recurrent urinary tract infections in children (3 boys, 62 girls) who received medical prophylaxis or underwent surgical correction of reflux. Thirty-eight children returned for reevaluation 6 to 13 years (average 9.5 years) after entry. There was a marked decrease in prevalence and severity of reflux. At entry, 13 had significant scarring that had progressed at follow-up. New scars were documented by dimercaptosuccinic acid scan at follow-up in eight children on the medical regimen and two who were initially treated with surgical correction of reflux. Four patients with high-grade sterile reflux were followed for 6 to 10 years without the development of cortical scars. Our data support the role of urinary tract infection and vesicoureteral reflux, but not sterile reflux, in the pathogenesis of chronic pyelonephritis and reflux nephropathy.

Adolescent↗
PubMed1985

Prospective DR matching for first cadaver donor renal allografts and retransplantation.

From January 1981 through 1983 80 cadaver donor renal allografts were transplanted at a single center utilizing prospective HLA-DR matching. All patients received at least two blood transfusions prior to transplantation. One year actual allograft survival of 77% for initial grafts and 57% for retransplantation was observed. When there was no DR mismatch the results were 84% and 80% respectively. Only 6% of no-DR-mismatch initial grafts were lost to rejection or patient death. These significantly better results were associated with decreased incidence of acute rejection episodes with transplants well matched for DR. Matching for A and B locus antigens conveyed no benefits in this series. Use of prospective DR matching for donor/recipient selection also resulted in efficient transplantation. Patients receiving initial grafts waited an average of 3.9 months while retransplanted patients waited an average of 13.5 months after being entered on the waiting list. The data suggest that if all transplant centers would preferentially share kidneys regionally on the basis of DR matching, nearly all patients could receive timely allografts with no DR mismatch and good results at one year with conventional immunosuppressive therapy.

Acute Disease↗
PubMed1984

Iga nephropathy: presentation, clinical course, and prognosis in children and adults.

Eighty-two patients, 56 male and 26 female, biopsied since 1972 had IgA nephropathy. At the time of kidney biopsy, 24 patients were children and 58 were adults. In both groups the clinical course was documented in sufficient detail to allow prediction of disease outcome. Twenty-six (45%) of the adult patients had chronic renal insufficiency either at first evaluation or subsequently. Fourteen eventually required chronic hemodialysis. Hypertension as the initial sign of disease was seen more frequently in patients with chronic renal insufficiency. Adult males were more likely to have chronic renal insufficiency. The life table method was used to predict age at initiation of dialysis and kidney survival from date of onset of clinically apparent disease. Thirty-five percent of the male patients were predicted to require dialysis by age 40. Kidney death was predicted at 10 years from onset for 33% of male and 22% of all patients biopsied as adults. While all patients with progressive disease had over 2.0 g/24 h urinary protein excretion at least once, many individuals with serum creatinine concentration below 1.5 mg/dL showed marked fluctuation in degree of proteinuria, often exceeding 2.0 g/24 h. Thus, in some cases, degree of proteinuria was not a reliable predictor of outcome.

Adolescent↗
PubMed1982

Current estimates of the incidence of steroid responsive idiopathic nephrosis in Kentucky children 1-9 years of age.

A review of the medical literature relating to childhood nephrosis revealed no surveys conducted since 1968 which either substantiated or refuted the range in incidence rates reported in earlier studies. Those rates ranged from 1.3 to 2.5 new cases per year among 100,000 white and non-white children under 10 years of age. The present report documents the incidence of steroid responsive idiopathic nephrosis in the eastern part of Kentucky during the years 1970 through 1979. The overall rate of 1.8 new cases per year was similar to that described in previous reports. A suggestion of an increased rural vs urban incidence was noted.

Adrenal Cortex Hormones↗
PubMed1981

Shunt nephritis. Role of the complement system in its pathogenesis and management.

Three cases of shunt nephritis in which serial complement levels were obtained during the course of treatment are presented to illustrate the value of monitoring complement levels in the management of this condition. In shunt nephritis, circulating immune complexes are formed which contain antigen from bacteria of low virulence. These complexes, which activate the classical complement pathway, are reflected in most cases by lowering of the serum levels of C1, C2, C4, and C3. These levels promptly return to normal after the initiation of effective therapy. Serial determinations of serum levels of complement protein provide a sensitive and reliable method for early determination of efficacy of therapy in shunt nephritis.

Anti-Bacterial Agents↗
PubMed1980

Focal and segmental glomerular sclerosis in reflux nephropathy.

Reflux nephropathy was diagnosed in 23 patients (14 per cent of all the patients who received transplants) between 1973 and 1977, and nephrectomy was performed in all. Histology and immunofluorescence revealed a glomerular sclerosis associated with the idiopathic nephrotic syndrome. No focal and segmental glomerular sclerosis was seen in kidneys removed from patients with nonglomerular renal disease. Twenty-four hour urinary protein excretion in grams was 3.1 +/- 0.3 (mean +/- SEM) and was greater than that in our patients with end-stage nonglomerular renal disease. Thirty-one renal transplants were performed in these 23 patients; thereafter, maximum protein excretion was 1.4 g. Focal and segmental glomerular sclerosis was seen in only one (chronic rejection, protein excretion less than 0.5) of the 20 kidneys available for histologic study. Thus, focal and segmental glomerular sclerosis is extremely common in reflux nephropathy, accounts for "glomerular" proteinuria and may contribute importantly to progressive renal failure but, unlike that associated with the idiopathic nephrotic syndrome, rarely recurs after renal transplantation.

Adolescent↗
PubMed1979

Renal transplantation for patients with type I and type II membranoproliferative glomerulonephritis: serial complement and nephritic factor measurements and the problem of recurrence of disease.

Fourteen patients with membranoproliferative glomerulonephritis as their original kidney disease received 16 renal allografts. All 14 patients are alive, 11 currently have functioning allografts, and one graft was lost to recurrence of membranoproliferative glomerulonephritis. Originally depressed serum complement (C3) concentrations returned to normal soon after transplantation in those patients with no clinical evidence of recurrence. Two patients with type II membranoproliferative glomerulonephritis had recurrence of disease. Nephritic factor (C3NeF) was high in both these patients before they received their transplants and was absent soon thereafter. However, abnormally high levels were again detected in their course. The one recurrence of type I membranoproliferative glomerulonephritis was associated with depressed C3, Clq, C4 and factor B but without C3NeF activity. Despite warnings of "high risks/ and "high mortality" associated with renal transplants in patients with membranoproliferative glomerulonephritis, we, because of these results and a review of the literature, continue to recommend renal transplants from both living related (LRD) and cadaver (CAD) donors in otherwise suitable patients who have renal failure due to membranoproliferative glomerulonephritis.

Adolescent↗
PubMed1979

Diffuse metanephric adenoma after in utero aspirin intoxication. A unique case of progressive renal failure.

Diffuse persistent glomerular immaturity and focal proximal tubular ectasia were seen in bilateral open renal biopsy specimens for an infant with fluid and salt depletion and slowly progressive renal failure. Subsequently, diffuse tubulopapillary renal adenoma subtotally replaced each kidney, thereby, necessitating renal transplantation. Origin of diffuse metanephric adenoma from persistent primitive epithelium of the proximal nephron is postulated and partly substantiated. We propose that this case of persistent proximal nephronic epithelial immaturity and diffuse metanephric adenoma is a variant of nephroblastomatosis and that in this case, a first trimester suicide attempt with aspirin may have initiated the maturation defect that preceded neoplastic transformation.

Aspirin↗
PubMed1977

Hematuria in childhood: significance and management.

Of 164 children presenting with gross or microscopic hematuria during a 5-year period 111 (68 per cent) were proved by clinical features or renal biopsy to have glomerulonephritis. Extraglomerular origin of hematuria was documented in only 25 (15 per cent). No definite diagnosis could be made in the remaining 28 (17 per cent) with isolated hematuria but the clinical picture was similar to that of the patients with mild glomerular lesions. Followup in 59 of 68 children confirms previous reports that isolated hematuria in childhood is usually a benign condition. Although excretory urography, urine cultures and serum complement measurements should be done to eliminate uncommon causes of hematuria, invasive studies, such as renal biopsy and cystoscopy, are not indicated routinely.

Adolescent↗
PubMed1975

Bartter syndrome. Typical facies and normal plasma volume.

Two girls with hypokalemic and hypochloremic metabolic alkalosis and failure to thrive were found to have Bartter syndrome at ages 9 and 6 months. Both had normal blood pressures despite substantial elevation of plasma renin activity and evidence of secondary hyperaldosteronism. A similarity in facial features, including prominent forhead, a large head, triangular facies with drooping mouth, and large eyes and pinnae, was noted in these two infants and in published pictures of other infants with the syndrome. Although the normotension associated with substanital elevation of plasma renin activity and hyperaldosteronism in Bartter syndrome has been considered the effect of hypovolemia, a normal or slightly elevated plasma volume was found in these infants, suggesting that in certain cases an alternate mechanism for the depressed response to renin may be present.

Bartter Syndrome↗
PubMed1972

The selective inhibition of macrophage phagocytic receptors by anti-membrane antibodies.

Rabbit antibodies were prepared against purified mouse macrophages, erythrocytes, and liver lysosomes. In the presence of complement each of these reagents was capable of lysing mouse erythrocytes and macrophages. In the absence of complement, all antisera agglutinated mouse erythrocytes and at high concentration produced a cytotoxic effect on macrophages. At IgG concentrations of 100 microg/ml, no morphological evidence of cytotoxicity was evident. These data suggest the presence of common antigens on the erythrocyte and macrophage plasma membrane. Anti-macrophage, anti-erythrocyte, and anti-lysosomal gamma-globulins and IgG, employed at subtoxic concentrations, all inhibited the attachment and ingestion of opsonized erythrocytes and mycoplasma. This occurred without significant reduction in the phagocytosis of polystyrene particles, formalinized erythrocytes, and yeast cell walls. Each of the anti-membrane IgG antibodies was capable of blocking the Fc receptor on the macrophage plasma membrane. Attachment to the macrophage membrane occurred by means of the Fab region. However, a role for the Fc portion of the molecule was suggested since pepsin-digested IgG was unable to block the receptor. Each of the IgG antibodies produced a partial blockade of the complement receptor and reduced the ingestion of EAC1,4,2,3 by approximately 50%.

Ammonium Sulfate↗